CARDIAC EXAM

Introduction

Knock, enter the room, wash/sanitize hands and introduce yourself
Greet the patient, ask the patient’s name, explain the exam and ask for consent
Always ask for vitals
- Mention that you will assess for pulsus paradoxus if suspicion for pericardial effusion
Advise and request patient to drape according to the exam being performed (Mention what type of exposure is necessary)

Patient can sit on the examination table for the inspection exam

General	Inspect for increased work of breathing, body habitus
Face	Inspect eyes for conjunctival pallor & scleral icterus Inspect skin near eyelids for xanthomata Inspect under tongue for central cyanosis
Hands	Inspect for splinter hemorrhages, janeway lesions, osler nodes, clubbing, peripheral cyanosis Press on fingernails to assess capillary refill time
Abdomen	Inspect for signs of coagulopathy (petechiae, purpura, ecchymosis) Inspect abdomen for surgical scars, ascites, or pulsations
Leg	Inspect for gross edema
JVP	Instructions in special test section

Transition statement and consent to begin palpating
Palpate bilaterally for relevant pulses: carotid, brachial, radial, and femoral
Palpate for heaves and thrills (feeling for hypertrophy and murmurs, respectively)
Palpate for point of maximal impulse (mention how it should feel (tap), size (quarter) and duration (⅔ of systole))
- Have pt lie in left lateral decubitus position, or, swing legs over side of bed and lean forward
Palpate for pitting edema

Transition statement: No percussion in the cardiac exam so we can move to auscultation